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Starting Neurohormonal Antagonists in Patients With Acute Heart Failure With Mid-Range and Preserved Ejection Fraction

Seko, Yuta Kato, Takao Morimoto, Takeshi Yaku, Hidenori Inuzuka, Yasutaka Tamaki, Yodo Ozasa, Neiko Shiba, Masayuki Yamamoto, Erika Yoshikawa, Yusuke Yamashita, Yugo Kitai, Takeshi Taniguchi, Ryoji Iguchi, Moritake Nagao, Kazuya Kawai, Takafumi Komasa, Akihiro Nishikawa, Ryusuke Kawase, Yuichi Morinaga, Takashi Toyofuku, Mamoru Furukawa, Yutaka Ando, Kenji Kadota, Kazushige Sato, Yukihito Kuwahara, Koichiro Kimura, Takeshi 京都大学 DOI:10.1253/circj.CJ-21-0977

2022.09.22

概要

Background: The clinical benefits of neurohormonal antagonists for patients with heart failure (HF) with mid-range and preserved ejection fraction (HFmrEF and HFpEF) are uncertain.

Methods and Results: This study analyzed 858 consecutive patients with HFmrEF (EF: 40–49%) or HFpEF (EF ≥50%), who were hospitalized for acute HF, and who were discharged alive, and were not taking angiotensin-converting enzyme inhibitors (ACE)-I/ angiotensin II receptor blockers (ARB) or β-blockers at admission. The study population was classified into 4 groups according to the status of prescription of ACE-I/ARB and β-blocker at discharge: no neurohormonal antagonist (n=342, 39.9%), ACE-I/ARB only (n=128, 14.9%), β-blocker only (n=189, 22.0%), and both ACE-I/ARB and β-blocker (n=199, 23.2%) groups. The primary outcome measure was a composite of all-cause death or HF hospitalization. The cumulative 1-year incidence of the primary outcome measure was 41.2% in the no neurohormonal antagonist group, 34.0% in the ACE-I/ARB only group, 28.6% in the β-blocker only group, and 16.4% in the both ACE-I/ARB and β-blocker group (P<0.001). Compared with the no neurohormonal antagonist group, both the ACE-I/ARB and β-blocker groups were associated with a significantly lower risk for a composite of all-cause death or HF hospitalization (HR: 0.46, 95% CI: 0.28–0.76, P=0.002).

Conclusions: In hospitalized patients with HFmrEF and HFpEF, starting both ACE-I/ARB and a β-blocker was associated with a reduced risk of the composite of all-cause death or HF hospitalization compared with patients not starting on an ACE-I/ARB or β-blocker.

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